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目的研究县级公立医院“取消药品加成”政策实施效果,为进一步完善相关政策提供参考。方法对某县级公立医院“取消药品加成”政策实施前后医药费用控制、医院收支、补偿情况等数据进行对比分析,以研究政策实施的实际效果。结果政策实施后药占比下降,由政策实施前的43.6%降至政策预期目标(30%);药品总费用增长率低于政策实施前,增速放缓;门诊病人次均药费、住院病人人均药费减少,差异具有统计学意义。门诊病人次均医药费用下降;住院病人人均医药费用并无明显下降;医疗总费用呈增长趋势,增长率先降后升,接近政策实施前的水平。同时县级医院收入结构趋于合理,但收支结余大幅下降。由政府增加投入及调整医疗服务价格而增加的医院收入不足以弥补“取消药品加成”所带来的损失。结论 “取消药品加成”政策在该县级公立医院实施以来,对控制医疗费用增长有一定作用,控制药品费用增长效果明显。患者医药费用下降。为巩固成效,还应建立多方共担长效补偿机制,同时重视医务人员收入的提高。
Objective To study the implementation effect of the policy of “canceling drug add-ons” in public hospitals at the county level and provide reference for further improving relevant policies. Methods The data of medical expenses control, hospital receipts and expenditures, compensation and other data before and after the implementation of a policy of “canceling drug additions” at a county-level public hospital were compared and analyzed to study the actual effect of policy implementation. Results After the implementation of the policy, the share of medicine dropped from 43.6% before the implementation of the policy to the expected policy target (30%); the growth rate of the total cost of medicines was lower than that before the policy was implemented; the average outpatient medication fee and hospitalization Patients per capita drug costs decreased, the difference was statistically significant. The out-patient medical expenses dropped; the per capita medical costs of inpatients did not drop significantly; the total medical expenses increased with the increase rate first and then decreased, approaching the pre-policy level. At the same time, county-level hospital income structure tends to be reasonable, but the balance of payments has dropped significantly. The increase of hospital revenue due to the increase of government investment and the adjustment of the price of medical services is not enough to make up for the loss caused by the “cancellation of drug additions.” Conclusion Since the implementation of the policy of “canceling drug add-ons” at the county-level public hospitals, it has a certain effect on controlling the growth of medical expenses, and the effect of controlling drug expenses increases obviously. Patients medical costs decreased. In order to consolidate the results, a multi-party long-term compensation mechanism should also be established, paying attention to the improvement of medical personnel’s income.